Maternal hemodynamics in early and late fetal growth restriction

Abstract

Fetal growth restriction is a challenging condition for the obstetricians associated to neonatal morbidity, unfavorable developmental outcomes, and long-term sequalae for the newborn. Guidelines divide this condition in two subtypes: early and late forms depending on biometric, Doppler parameters, and the gestational age at appearance (before or after 32 weeks gestation). This condition is associated to a maternal cardiovascular profile detectable in the pre-conceptional period, in the early stages of pregnancy, as well in the second and third trimester of pregnancy. The maternal cardiovascular alterations are similar in the two subtypes of fetal growth restriction, although they differ in the degree of expression. Echocardiography and other non invasive cardiovascular devices are very useful for the characterization of the maternal cardiovascular profile, and allow the early identification of patients at risk for this pathological condition. The particular maternal hemodynamic profile at the base of the development of fetal growth restriction is characterized by a hypovolemic hypodynamic state. This particular cardiovascular condition might be susceptible to be modified by promising non pharmacological and pharmacological interventions, although they need further clinical investigations to be routinely used.

Keywords: Early fetal growth restriction; Echocardiography; Late fetal growth restriction; Maternal cardiac performance; Maternal hemodynamics; Nitric oxide donors; Total peripheral vascular resistance.